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Health Insurers Fear Impact Of Trump's Vague Order On Affordable Care Act


One of Donald Trump's first official actions as president took aim at the Affordable Care Act. President Trump issued a sweeping executive order on Friday just after the inaugural parade. It directs heads of federal agencies to ease what it calls Obamacare's burdens on everyone from patients to medical device makers. NPR's Alison Kodjak reports that the order is so broad; it's left lawmakers and policy specialists wondering exactly what it might do.

ALISON KODJAK, BYLINE: Trump's order tells the incoming secretary of Health and Human Services and all the other agency leaders to, quote, "waive, defer, grant exemptions from or delay," unquote, the implementation or enforcement of Obamacare rules. But what the order will actually do remains unclear, even to Republican lawmakers like Sen. Susan Collins of Maine.


SUSAN COLLINS: I think that the executive order is very confusing, and that we really don't know yet what the impact will be.

KODJAK: Collins spoke to reporters after she and Louisiana Sen. Bill Cassidy introduced their proposal to replace Obamacare. She says an executive order is not the way to fix the ACA. Still, the order could have an immediate impact on the health insurance markets depending on how aggressive Trump wants to be. And right now his intentions aren't obvious, says Joel Michaels, a partner at the law firm McDermott Will & Emory.

JOEL MICHAELS: It's not clear whether, you know, they'll use this to begin to actually implement destabilizing provisions.

KODJAK: Like deciding not to enforce the requirement that everyone buy health insurance. And if Trump does nothing, that could prove destabilizing too because it could make people think they don't have to buy health insurance and leave insurers wondering who their customers will be.

MICHAELS: Some would argue that the lack of clarity and the uncertainty in an already fragile health insurance market could have that effect.

KODJAK: Karen Pollitz, a senior fellow at the Kaiser Family Foundation, is confused by the order, too.

KAREN POLLITZ: Yeah. We're all, I guess, grasping on this one to figure out what could happen.

KODJAK: She says the order allows agencies to grant waivers from many of the requirements of the Affordable Care Act, so the government could give lots of people hardship waivers so they don't have to buy insurance.

POLLITZ: The departments could look at broadening what constitutes a hardship, and then granting those exemptions much more liberally than would have been the case under the prior administration.

KODJAK: Or it could go bigger, granting waivers to entire states. They could then trim the list of benefits insurance companies have to include in their policies. Maybe they won't cover childbirth, annual checkups or birth control. Or the government could allow people to buy old fashioned insurance, the stripped down policies that don't cover preventive care or pre-existing conditions. Right now those policies are available only to a handful of people who got waivers from the Obama administration years ago.

POLLITZ: That's just sort of another area where I think they might look to make other cheaper policies available that already exist at least for some people, and that are cheaper because they don't comply with all of the ACA consumer protections.

KODJAK: Hypothetically, Trump's new administration could go even further, but the new president has said he wants Republicans in Congress to come up with a way to guarantee health insurance for everyone before the current system disappears. Alison Kodjak, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.